Understanding the Relationship Between Patient-Reported Function and Actual Function in the Upper Limb Prosthesis User Population: A Preliminary Study

Xuyuan Zhang; Kerstin S Baun; Lauren Trent; John Miguelez; Kimberly Kontson

doi:10.1016/j.arrct.2021.100148

Understanding the Relationship Between Patient-Reported Function and Actual Function in the Upper Limb Prosthesis User Population: A Preliminary Study

Arch Rehabil Res Clin Transl. 2021 Jul 24;3(3):100148. doi: 10.1016/j.arrct.2021.100148. eCollection 2021 Sep.

Authors

Xuyuan Zhang^{1

2}, Kerstin S Baun³, Lauren Trent³, John Miguelez³, Kimberly Kontson¹

Affiliations

¹ Center for Devices and Radiological Health, Office of Science and Engineering Labs, United States Food and Drug Administration, Silver Spring, MD.
² School of Public Health, University of Maryland, College Park, MD.
³ Clinical Services, Advanced Arm Dynamics, Redondo Beach, CA.

Abstract

Objective: To understand how perceived function relates to actual function at a specific stage in the rehabilitation process for the population using upper limb prostheses.

Design: Quantitative clinical descriptive study.

Setting: Clinical offices.

Participants: A sample of 61 participants (N=61; mean age, 43.0±12.8y; 51 male/10 female) with upper limb amputation who use a prosthetic device and were in the definitive stage of a prosthesis fitting process.

Interventions: Not applicable.

Main outcome measures: A patient-reported outcome measure, the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH), and 2 performance-based outcome measures, Box and Blocks Test (BBT) and Capacity Assessment of Prosthesis Performance for the Upper Limb (CAPPFUL), were used as variables in multiple linear regression models.

Results: The multiple linear regression models, which controlled for prosthesis type and amputation level, did not show evidence that changes in the independent variable (DASH) are significantly associated with changes in the dependent variables (log(BBT) (B=-0.007; 95% confidence interval [CI], -0.015 to 0.001; P=.0937) and CAPPFUL (B=-0.083, 95% CI, -0.374 to 0.208; P=.5623)). In both models, individuals with elbow, transhumeral (above elbow), and shoulder disarticulation showed a significant negative association with the dependent variable (CAPPFUL or logBBT). In the CAPPFUL model, there was a significant negative association with individuals using a hybrid prosthesis (B=-20.252; 95% CI, -36.562 to -3.942; P=.0170). In the logBBT model, there was a significant positive association with individuals using body-powered prostheses (B=0.430; 95% CI, 0.089-0.771; P=.0157).

Conclusions: Although additional data and analyses are needed to more completely assess the association between self-reported measures and performance-based measures of functional abilities, these preliminary results indicate that patient-reported outcomes alone may not provide a complete assessment of an upper limb prosthesis users' functional ability and should be accompanied by population-specific performance-based measures.

Keywords: ADL, activities of daily living; Amputees; BBT, Box and Blocks Test; CAPPFUL, Capacity Assessment of Prosthesis Performance for the Upper Limb; DASH, Disabilities of the Arm, Shoulder, and Hand questionnaire; Outcome assessment, health care; PRO, patient-reported outcome; Patient reported outcome measures; Prosthesis; Rehabilitation; Upper extremity.